title: Surgeon volume does not predict outcomes in the setting of technical credentialing: results from a randomized trial in colon cancer.
abstract: OBJECTIVE
  To test the hypothesis that surgeon volume would not predict short- and long-term outcomes when evaluated in the setting of technical credentialing.
  
  
  BACKGROUND
  Surgical volume is a known predictor of outcomes; the importance of technical credentialing has not been evaluated.
  
  
  METHODS
  Fifty-three credentialed surgeons operated on 871 patients in the Clinical Outcomes of Surgical Therapy Study (NCT00002575), investigating laparoscopic versus open surgery for colon cancer. Credentialing required that each surgeon document performance of at least 20 laparoscopic colon cases and demonstrate oncologic techniques on a video-recorded case. Surgeons were separated based on volume entered into the trial (low, < or =5 cases (n = 39); medium, 6-10 cases (n = 9); or high, >10 cases (n = 5)) and compared by outcomes.
  
  
  RESULTS
  Patients treated by high volume compared with medium or low volume surgeons were older (70, 66, and 68 years; P < 0.001), more often had right-sided tumors (63%, 46%, and 53%; P < 0.001) and had more previous operations (48%, 38% and 45%; P < 0.004), respectively. Mean operative times were shorter (123, 147 and 145 minutes; P < 0.001), distal margins longer (13.4, 12.4 and 11.6 cm; P = 0.005), and lymph node harvest greater (14.8, 12.8, 12.6; P = 0.05) for high versus medium versus low volume surgeons. However, rates of conversion, complications, 5-year survival, and disease-free survival showed no significant differences.
  
  
  CONCLUSIONS
  When tested in a randomized controlled trial with case-specific surgical technical credentialing and auditing, surgeon volume did not predict differences in rates of conversion, complications, or long-term cancer outcomes. Case-specific technical credentialing should be further studied specific to the role it could play in creating consistent, high quality outcomes.
authors.affiliation: Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA. larson.david2@mayo.edu
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.forename: Sergio W
authors.initials: SW
authors.lastname: Larach
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: Adrian
authors.initials: A
authors.lastname: Park
authors.forename: John
authors.initials: J
authors.lastname: Marks
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.forename: Alan G
authors.initials: AG
authors.lastname: Thorson
authors.forename: Tonia M
authors.initials: TM
authors.lastname: Young-Fadok
authors.forename: Erin
authors.initials: E
authors.lastname: Green
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sargent
authors.forename: Heidi
authors.initials: H
authors.lastname: Nelson
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003082:Colectomy / Q000592:standards* / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000401:mortality / Q000601:surgery*; D003107:Colorectal Surgery / Q000592:standards / Q000706:statistics & numerical data; D003406:Credentialing; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome